ASSESSING IMPLEMENTATION OF IMCI STRATEGY IN THE PHILIPPINES

Dr. E. B. Tandingan, Dr. D.C. Fajardo, E. Villate,Dr. R. Moench-Pfanner, Dr. S. de Pee Helen
Keller International Philippines and Asia-Pacific

Contact
Dr. Edward B. Tandingan
Program Development Specialist
Helen Keller International-Phil
1004
Philippines

Telephone +6325259457
Email address edtandingan@hki.com.ph

ABSTRACT

Background
The Philippine Department of Health (DOH) adopted the Integrated Management of
Childhood Illness (IMCI) strategy to address the country’s problem of child morbidity and
mortality. This strategy improves the case management skills of health workers, selected
health systems operations, and family/community practices in childcare. Health workers
implement the strategy over many parts of the country. In Regions 1, 3, 10 and 11, Helen
Keller International (HKI) provided technical assistance since 2000 to improve IMCI strategy
implementation.

Objective
To assess the implementation of the health care system component of the IMCI and the IMCI
case management skills of health workers.

Methods
Using a cross sectional study design, trained data collectors (DOH and HKI) observed 33
IMCI-trained health workers that had been trained and implemented IMCI since 18 months, as
they provided services for sick children in 34 purposively selected health facilities in three
provinces each of Regions 1, 3, 10 and 11. Later, they interviewed separately the
nurse/midwives and the mothers/caretakers of the sick children, and conducted a review of
facility records. Assessment tools used were those developed, by WHO which had then been
adapted for local use.

Results
Health workers index of integration was high at 8.9%, however, they miss out on some of the
essential IMCI steps of assessing, classifying and treating/managing, such that almost 90% of
sick children are inappropriately managed. Factors attributed were, not enough cases during
training, not used to assessing other aspects of nutrition and immunization and necessary
support systems were generally deficient. Over half (54%) of the health workers had received
supervisory follow-up visits that included case management observation. End-users of
supplies and equipment were not involved in the procurement pro cess so that supplies and
equipment purchased were inappropriate or inadequate. Non-uniformity of the recording
system for services provided through IMCI makes it difficult to come up with overall service
statistics on IMCI. While a referral system exists, referral for children with severe illness is
sometimes delayed, and referred sick children are rarely followed-up after discharge from the
referral facility.

Conclusion
Implementation of the IMCI strategy is not optimal due to various causes that can otherwise
be overcome by local interventions (improved supervision, proper procurement procedures,
proper staff utilization, some training modification).